4 - Nausea / Vomiting Flashcards by Karlo Sison

Emetrol

Phosphorylated Carbohydrate Solution

Dose / Indication

Fructose, dextrose, orthophosphoric acid

ANTIEMETIC

upset stomach / food indiscretions / emotional upset

Adults:

15-30ml q15min

(1-2 Tablespoons), until nausea subsides

Max 5 doses in 1 hour, no longer than 1 hour

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Emetrol

Consultation

Fructose, dextrose, orthophosphoric acid

Do not Dilute solution or Drink Fluids prior to use*
Wait 15 minutes prior to last dose*
DNT for more than 1 hour (5 doses)*

not for children or newborns

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Emetrol

Adverse Effects

Phosphorylated Carbohydrates

Abdominal Cramping

Diarrhea

15-30ml q15

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Emetrol

CI’s & Precautions

Phosphorylated Carbohydrates

DNU in newborns / children unless DR*
DNU w/ Diabetics high SUGAR content*
DNU w/ Hereditary fructose intolerance (HFI)*
<5 doses in 1 hour*

15-30ml q15min

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Bonine / Meclizine

Indication

Motion Sickness Medication

chewable / 25mg tablets

Treats & prevents adults w/

Nausea / Dizziness / Vomiting

(associated w/ motion sickness)

1-2t QD, 1 hr before activity

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Meclizine / Cyclizine

Bonine

Dose

1-2 Tablets (25-50mg) QD

1 Hour before

engaging in activity that causes motion sickness

Can be CHEWED OR SWALLOWED

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Bonine / Meclizine

Consultation

Drowsiness

Avoid Alcohol / alertness needed in activities

Clear View

PMH: Asthma / Glaucoma / BPH

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BONINE / Meclizine / Cyclizine

Adverse Effects

Drowsiness

Dry Mouth

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BONINE / Meclizine / Cyclizine

CI’s + PC’s

Paradoxical Stimulatory in children

DNU in children <12 y/o*
DNU in pt w/ PMH of BPH/asthma/urination issue/glaucoma*

CNS Depression - Alcohol / depressants

PCAT - B

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DRAMAMINE

dimenhydrinite / meclizine / ginger

Indication

Motion Sickness Medication

Relief of Nausea / Dizziness / Vomiting (MS symptoms)

50Tab / Chewable / Kids 25mg

1-2t (50-100mg) q46 or 30min b4

max 8tab in 24 hrs

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Meclizine Vs Other MS medications

Meclizine may be LESS SEDATING

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DRAMAMINE

dimenhydrinite / meclizine / ginger

DOSE

1-2tabs (50-100mg) Q46

30 minutes b4 activity

Max 8 Tabs (400mg) in 24 hours

less drowsy formulation only for adults, 2 tabs max

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DRAMAMINE

dimenhydrinite / meclizine / ginger

Consultation

Same As Bonine/meclizine

Drowsiness

Avoid Alcohol / alertness needed in activities

Clear View

PMH: Asthma / Glaucoma / BPH

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DRAMAMINE

dimenhydrinite / meclizine / ginger

AE’s

Same as Bonine / meclizine

Drowsiness

Dry Mouth

ANTICHOLINERGIC

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DRAMAMINE

dimenhydrinite / meclizine / ginger

CI’s + PC’s

Similar to Bonine

Paradoxical Stimulatory in children

DNU for children <2 y/o

(vs 12 y/o with meclizine)

CNS depression - alcohol + CNS depressants

PMH of asthma / glaucoma / BPH

PC - B

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Symptoms of NV

Nausea

feeling of needing to vomit

Retching

involuntary diaphragm/ab contractions

Vomiting

Rapid/forceful expulsion of GI tract contents

Types of N/V

Motion Sickness

NVP (pregnancy)

Overeating / eating disagreable foods

Food Poisoning / Viral Gastroenteritis

Medication Use

Episodic / Situational NV

Complications of NV

Dehydration

Electrolyte / A-B Imbalance

Esophageal Tears

Aspiration / Malnutrition

Diaphragmatic HERNIATION

Mallory-Weiss Syndrome

Exclusions for Self-Treatment (EX-S-T)

N/V

Head Injury

Urine Ketones / High BG

Food poisoning >24 hours

ab pain in mid or right lower quadrent

BLOOD in vomitus

Yellow skin/eye

Dark Urine

STIFF NECK

EX-ST

NV for CHILDREN

Severe DEHYDRATION

caregiver unable/willing to manage at home

Motion Sickness Facts

Better to PREVENT vs treating

rare in kids <2 y/o, more common in WOMEN

Overstimulation of Labrinth apparatus

fluid in canal moves -> postural adjustment / 2 axis

-> unusual motion patterns

Motion Sickness Treatment

Antihistamines: Meclizine / Cyclizine / Dimenhydrinate

Bonine / Dramamine

Meclizine may be less sedating

Motion Sickness Prevention

Avoid Reading during Travel*
Avoid excess Food / Alcohol before&during travel*

Focus on the line of vision fairly straight ahead

avoid Strong odors

Drive vehicle

N/V in PREGNANCY

50-80% in EARLY pregnancy

subsides by 20th week in 80% of women

MultiFactoral

Accupressure

GINGER

**NVP** **Treatment**

**Diclegis** (Pyridoxine + Doxylamine) Extended Release **RX ONLY** **Pyridoxine 10-25mg TID** +/- **Doxylamine 10mg TID** **This is OTC** Doxylamine / dimenhydrinate effective *but not a lot known about fetal outcomes*

**Preventing NVP**

**Fresh Air** Dry crackers 10-15 min b4 getting out of bed (slowly) 4-5 small meals, ***do not overeat*** *Avoid **Fluids or Soups** at meals* When nauseated, sip **co2 beverages / fruit juice** *avoid greasy / spicy / fatty / acidic foods* Eat **Dry / Bland / High-protein foods / Chilled**

**Overeating & Treatment**

Gut Distention + *Decreased GI emptying* --\> **Stimulation of mechanoreceptors** **Emetrol - 15-30ml q15** (phosphorlated carb solution) (**HYPERosmolar)** acts on GI to ***decrease smooth muscle contraction*** *delay gastric emptying time*

**Acute Viral Gastroenteritis**

Inflammation of stomach / SI Presents w/ **Acute Vomiting + Diarrhea** Self-limiting - **_Gone after 24 Hours_** *can be serious with children due to **dehydration***

**S/S of DEHYDRATION** **in children**

**Sunken Eyes / Fontanelle** Dry eyes, Decreased skin tugor **Dark /*little Urine*** *Absence of **tears*** **Weight LOSS** (small abdominal size) **Lethargy / sleepiness / *decreased alertness* / Irritability** *difficulty waking child / lightheaded*

**Treatment for Dehydration**

**ORS** (oral rehydration therapy) **Glucose Based ORS** (gatorade) more **ISOMOLAR**, more effective at rehydrating vs water *Fluid absorption may be COMPRIMISED in pts with:* **continuous vomiting** *\> more difficult than **diarrhea***

**ORT Ideal Osmolarity**

**245** ## Footnote **(mOs m/L)** WHO-ORS Pedialyte = 249 Gatorade = 330 (lot of sugar)

**Gatorade as ORT**

OSM = **330** (close to 245) *But a lot of **SUGAR*** too much sugar -\> **DRY in GI tract** ultimately want **_Sugar:Sodium ratio of 3:1_**

**ORT for *Minimal Dehydration***

Children ***_\<10kg_***: ***60-120ml*** after each vomiting episode Children **_\>10kg_**: **_120-240ml_** after " *if **severe _REFER to ED for IV fluid replacement_***

**ORT for Mild-Moderate Dehydration**

Children: **50-100ml/kg** **_OVER_ 3-4 hours** _Weight based, over 3-4 hours_ *if severe REFER to ED for IV fluid replacement*

**ORT for ADULTS**

replace **30-50%** of fluids lost in first **24 hours** mainly gauge how you feel drink **ORS**

**Pedialyte Freezer Pops**

**Taste much better when COLD** Offered **10 min after** last episode of vomiting **5ml q5min** for children **15ml q5min** for older children / adults

**Complementary Therapy** **for NV**

**Ginger** 250mg (root) po QID for NVP / MS / Surgery **Accupressure** P6 point on wrist, wristband 10min TID or continuously **Aromatherapy** Peppermint Oil / Isopropyl Alcohol

**Determining Dehydration in Children**

**Weight loss /** ***Decrease in abdominal size*** **\<3%** (minimal), **3-9%** (mild-moderate), **\>9%** (severe)

**OTC NVP Treatment** **& Dose**

**Pyridoxine 10-25mg TID** with or without **Doxylamine 10mg TID** **This is OTC**